Leaving no one behind: A call for action to ensure migrant’s health & wellbeing

Migration is a social determinant of health that can impact the well-being of an individual, as well as the community at large, writes Dr Anjali Borhade on the eve of International Migrant Day that falls on 18th December

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The United Nation’s ‘International Migration Day’ is annually held on 18th December to recognize the efforts, contribution and rights of migrants worldwide. The world is experiencing migration on an unprecedented scale. There are an estimated 1 billion migrants today- one in seven people!
While some people migrate seeking better opportunities, others are forcibly displaced, fleeing conflict and war. The number of people who migrated across international borders surged by 41 percent in the last 15 years to reach 244 million in 2015. Internal migration (which takes place within one’s own country) is estimated at 740 million people worldwide. Estimated internal migrants in India are 120 millions. Migration continues to evolve and to become more complex through increased mixed migration flows comprised of many categories of migrants, involving both traditional and new countries of origin, transit and destination. Additionally, the socio-economic, bio-environmental and political context within which modern migration takes place keeps changing, determining new challenges and areas of opportunity, including in the health sector, towards the realization of migration as an effective poverty-reduction and development-enabling factor.
Migration is a social determinant of health that can impact the well-being of an individual, as well as the community at large. Most migrants are healthy and young, and migration can improve the health status of migrants and their families by providing a safer haven or better education and purchasing power for ‘left behind’ family members, thanks to remittances. However, the migration process can also expose migrants to health risks and many migrants lack access to adequate, equitable health services and financial protection. Health systems may not have sufficient capacity to manage migrant health needs especially in the case of large movements. Furthermore, human mobility, whether resulting from internal or international migration can be a critical factor in the spread of disease and/or a challenge to controlling it. The Ebola crisis reminded us how a lack of preparedness, targeted health services and surveillance along mobility pathways undermines effective disease control measures.
Resetting the agenda of migrant health
Acknowledging the inherent connection between migration and health, WHO Member States adopted the 2008 World Health Assembly (WHA) Resolution on the health of migrants (WHA.61.17). The Resolution paved the way for the 2010 Global Consultation on Migrant Health in Madrid, which was co-organized by IOM, WHO and the Government of Spain and defined an operational framework to guide Member States and stakeholders in implementing the strategies of mentioned Resolution. This Operational Framework reaffirmed the need of adopting a rights-based, equity-driven, health system strengthening, multi-sectoral approach in addressing health and migration and identified four priority areas for action, namely: monitoring of migrants’ health; policy and legal frameworks; migrant-sensitive health systems; and, partnerships, networks and multi country frameworks. Yet while awareness and recognition of the urgency to adapt policies and programmes, across sectors, to the health challenges brought by global human mobility is on the rise, the adaptation and development of necessary technical and policy instruments remains slow.
Governments are faced with the challenge of integrating the health needs of migrants into national plans, policies and strategies across sectors, responding to the call to ‘leave no one behind’ and achieve Universal Health Coverage, stated by the 2030 Sustainable Development Goals. Coordinated efforts are needed to ensure that migrant health is addressed without discrimination throughout the migration cycle, as are efforts to adapt and strengthen the resilience of local health systems in light of more diverse population health profiles. Addressing the health needs of migrants and affected local populations reduces long-term health and social costs, facilitates integration and contributes to social and economic development.
At the 106th IOM Council in November 2015, a High-level Panel on Migration, Human Mobility and Global Health was organized. During the Session, the President of the Democratic Socialist Republic of Sri Lanka, His Excellency Maithripala Sirisena, offered to host a Global Consultation on migrant health. In addition, during the 69th World Health Assembly in May 2016, a Technical Briefing session was dedicated to the topic of ‘Migration and Health’. WHO Member States also debated and took note of the Secretariat report on ‘Promoting the Health of Migrants’ (WHA A69/27).
In September 2016, during the UN General Assembly Summit on Large Movements of Refugees and Migrants, IOM, WHO and UNHCR co-organized a Side Event on Health in the Context of Migration and Forced Displacement, which was sponsored by the Governments of Sri Lanka and Italy. These selected milestones are a testimony of the fact that migration and health is a topic of interest for many governments today and requires a dedicated and in-depth discussion to redefine the global agenda, taking stock of current trends and perspectives.
The UN General Assembly Summit on Large Movements of Refugees and Migrants has created a unique opportunity for the global community to forge a greater consensus on managing the world’s movements of migrants and refugees. It also set in motion the development of a roadmap to a Global Compact for Safe, Orderly and Regular Migration and a Global Compact for Refugees. The Global Consultation will be an important milestone to ensure adequate reflection of the health of migrants within the mentioned Global Compacts.
The 2nd global consultation on migrant health 
In response to the renewed international attention to the topic, IOM, WHO and the Government of the Democratic Socialist Republic of Sri Lanka jointly organized the 2nd Global Consultation on Migrant Health during 21-23 February 2027 in Colombo, to offer Member States and partners a meaningful platform for multi-sectoral dialogue and political commitment to enhance the health of migrants.
Sri Lanka has set an example by formulating National Migration Health Policy for internal and international migrants.  The policy has adopted evidence-based & multi-stakeholder approach for promotion of the right to health. It also ensures co-ordination with thirteen key government ministries to address other social protection needs of these migrants, including skill building, insurance, housing, education etc. Asian countries including India has much more to learn from SriLanka’s experience.
During the key note address Honorable Minister of health Dr. Rajitha Senaratne stated that “The current Migrant Health Policy was introduced under the patronage of former Minister of Health and current President His Excellency Maithripala Sirisena and we can proudly say that it is a comprehensive policy which covers every aspect of health issues faced by migrants”
The Colombo statement was adopted on the closing day of the 2nd Global Consultation on migrant Health. Demonstrating the high level commitment to migrant health, the President of Sri Lanka, H. E Maithripala Sirisena, IOM Regional Director for Asia and the Pacific, Dr Nenette Motus, WHO Regional Director for South East Asia, Dr Poonam Khetrapal Singh and senior government representatives from over 40 countries participated in the meeting.  
The Colombo Statement calls for mainstreaming migrant health into key national, regional and international agenda and promotes international solidarity for equitable migrant health policies, a shared research agenda and the development of global frameworks to ensure migrant health is protected.  The momentum generated by the global consultation was carried forward to the World Health Assembly in May 2017, where 194 countries deliberated on priority actions to protect the migrants’ right to health and wellbeing.
Why India is an important patron in global migration scenario?      
Migration for livelihood is growing phenomenon in India. People’s migration in India is on high rise, both international as well internal migration. Approximately 29% of India’s population is migrating internally. According to the estimates from the National Sample Survey data in India, over US$3.846 billion was sent by international migrants and US$7.485 billion by internal migrants in 2007/2008.    These evidences suggest that migration can play an important role in poverty reduction and economic development.  Migrant population is normally missed out at source and destination from all social welfare development programs, such as livelihood, education, health, insurance, legal protection etc.  Hence positive facilitation of safe migration should be specially emphasized which mainly includes access to basics and public services mainly health, education and livelihood.   
Modi Government’s ambitious ‘Skill India Mission’ and ‘Make in India’ Programs have created newer opportunities for youth in semi urban and urban areas, and to quite an extent, at international level as well, and this environment has been instrumental in facilitating and increasing migration.
India being Asia’s largest and most influential labour sending county, has greater role to play on these issues at international level.  India is facing migration challenges and has increasing need to formulate and implement strategies to improve migrants’ condition both internal and cross border. Currently, India has less or no structural policies or programs targeting the migrant’s issues in totality.  Its high time Indian government must ensure coherence between national and international policies for migration and development. The Indian Government can borrow from the evidence-based policies and programs like Sri Lanka, and adapt them to the Indian scenario. There is a need to modify the existing policy structure and programs so that the needs of this marginalized group are accommodated in the various national programs, including health and other social protection. Development of a comprehensive National Migration Policy would be proactive step towards it, that can ensure health and welfare of those who migrate.  After all, migrants are key group contributing to the economic development of the India by working in precarious conditions and need to get equitable fruits of growth as other sections of the society.
In the direction of improving the plight of migrants, Disha Foundation was founded in 2002 in Maharashtra, mainly to facilitate safe and productive internal labour migration. Over period of last 14 years, many solutions were tested to reach out to migrant workers, including research, interventions on health, livelihood, social security, food security, education, and also tireless advocacy with regional and national government to mainstream migration issue into policy discourse. Government’s response has been changing and there is positive dialogue on creating pro-migrant policy response, such as Odisha Labour department has set up Migration support programme for their outgoing labourers, Jharkhand government has set up helpline and anti-trafficking support unit for migrant workers, Maharashtra tribal department set up tribal migration research and resource center for tribal migrants.
There are many successes at regional levels to create integrated solutions to address migrant’s diverse needs, and these successes need to be up scaled at national level, including creating migrant specific database and  portability of health insurance /social security services. Currently, due to sustained advocacy by Disha, Ministry of Tribal Affairs is actively looking into these issues, and working to build integrated model to address tribal migrants needs at source and destination level, which can be well applied for other social groups as well. But the process so far has advanced at a slow pace and is need of a dynamic leadership in the government for the cause of migrants- both for internal and international. Such a leadership can ensure engagement of different ministries, and put together a comprehensive migration policy which can act as an umbrella for the rights and welfare of internal and cross border migrants of India.

About Author: Dr Anjali Borhade is the Founder Director of Pioneer NGO Disha Foundation, working towards promoting safe and productive labour migration in India. She is PhD (in Migration, health and social security policies  in low and middle income countries) from Nuffield Department of Population Health, University of Oxford.  She has contributed towards creating migrant sensitive and migrant friendly Programmes and policies with India and at South-East Asia level.    

*Note: This is a contributory article and the views expressed by the author are her own.